Management and Handling of Vaccine in a Large Community-Wide Drive-Thru Point of Dispensing for H1N1 Pandemic Influenza Immunization

Background: Dispensing and administering H1N1 immunization to citizens has been a planning and logistical challenge.  A partnership between the University of Louisville and the Louisville Metro Department of Public Health and Wellness elected to utilize a unique community-based immunization approach consisting of walk-up and drive-thru options for adults and children where healthcare personnel administered both injectable and intranasal H1N1 influenza vaccine.  Maintaining the vaccine to ensure proper cold chain, handling, accurate dosage and administration were priorities and posed unique challenges in the drive-thru.  

Setting: Large community drive-thru held at a football stadium parking lot.  

Population: Adults and children in targeted populations seeking immunization at a large community-wide drive-thru immunization program.

Project Description: On November 11-12, 2009 a community-wide H1N1 immunization point of dispensing (POD) was held consisting of a drive-thru with ten separate lanes and a walk-up tent.  During those two days, a total of 19,079 vaccines were administered with 12,613 (66.1%) being administered via drive-thru.  Multidose vials of vaccine had been used to prefill individual syringes by University Hospital pharmacy personnel using standard USP practices.  Color coded labels were used on adult and pediatric doses of injectable and  intranasal vaccine doses.  Vaccine was maintained in temperature monitored vaccine refrigerators with control managed by one individual.  Doses were released to each drive-thru lane in controlled increments.  Timing of doses outside the vaccine refrigerator was monitored by tracking marked sample doses. 

Results/Lessons Learned:Throughput for each lane ranged from 60-100 individuals per hour.  All marked doses were utilized within two hours of release from the refrigerated environment.  . No errors in vaccine management or handling were identified.  Adequate maintenance of the cold chain was verified.. Color coding methods assisted with separation of vaccine manufacturers and doses and enabled rapid documentation.  Walkie-talkie communication enabled communication between nurses and the vaccine controller and supported maintenance of the cold chain.